I work in a large city in a large NICU and we are in the porcess of doing
some staff education, reworking and policy/procedure development.

I have a couple of questions that I am hoping someone can address and/or
answer for me - talking Preemies here - not normal term newborns!!!!!!

Does human milk fortifier alter the gut permeability and establish other
flora like formula does, in terms of contribuing to the development of NEC?
Can someone refer me to appropriate studies or any body of information on
this? I can find plenty of studies on human milk fortifier and growth for
preemies, but I am more interested in the permeability/flora in
micro-preemies  as those babies are at higher risk for NEC.

We have a couple (ok - many) nurses/docs/OTs/NNPs who insist on using
bottles when mom really wants to breast feed because there is suspicion that
bottle feeding will teach the baby to eat better and get them home faster.
In MY experience I have seen a number of these babies aspirate on the
bottle. However the responses I get are "We can't prove that the baby is not
aspirating on the breast either" (Never mind that the baby is not blue and
gasping for air on the breast) or "The baby doesn't feed well at the breast"
(Of course he doesn't - he has had a bottle shoved in his mouth QO feed) OR
"Mom cannot be here 24 hours a day to breastfeed" (Did they even ask her?)

Are there studies that provide info on aspiration re breast vs bottle? I
have not been able to locate any. I was wondering if there was anyone out
there who is doing ultrasonography or some other sort of study that would
support or not support the issue of aspiration on the breast.

I did hear at a conference I went to recently that preemies were MORE likely
to aspirate on the bottle than on the breast as they cannot control the rate
and flow of a bottle nipple.

Can anyone provide me numbers as to their breastfeeding rates in the NICU's
AND the number of G-tube placements they do per year? I suspect there may be
an inverse correlation and we are currently working on this as a small
study, but some preliminary numbers would be very very helpful in garnering
support.


Thanks!
Michelle Meeks, RN

------------------------------------------------

"Bad science sets out to make a point, looks neither to the left nor to the
right but only straight ahead for evidence that supports the point it sets
out to make. When it finds evidence it likes, it gathers it tenderly and
subjects it to little or no testing".
- Mark Vonnegut, The Boston Globe 10/24/1999

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